Prevalence of Body Dysmorphic Disorder in Patients Seeking Orthognathic Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Body dysmorphic disorder (BDD) is an obsessive compulsive condition characterized by excessive concern over minor or unnoticeable physical flaws. It has been underreported in patients undergoing orthognathic surgery (OS). The absence of quantitative synthesis limits our understanding and hinders the development of effective psychological screening and interdisciplinary surgical care strategies.

Purpose: The purpose of the study was to estimate the overall prevalence of BDD in adult patients being evaluated for OS.

Data sources: A comprehensive search in EBSCOhost, LiLACS, PubMed, Scopus, and Web of Science was independently conducted by 2 reviewers for articles published until March 6, 2025, with no restrictions on the starting publication date. MeSH terms and keywords related to the prevalence of BDD in OS were used.

Study selection: Observational studies (cross-sectional or longitudinal prospective or retrospective cohort studies) that assessed the prevalence of BDD in patients being evaluated for OS were included. Two independent reviewers checked the inclusion criteria and screened the articles. Discrepancies were resolved through consensus.

Data extraction and synthesis: Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for SR addressing questions of prevalence. Qualitative and quantitative syntheses of the articles were conducted using a random effects proportion meta-analysis under a generalized linear mixed model. Certainty of the evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Registration: PROSPERO CRD420251006016.

Main outcome and measure: The primary outcomes were the prevalence of BDD in OS patients (%) and the screening tools for BDD. As a secondary outcome, the risk of bias and certainty of the evidence across the included studies were assessed to determine the strength and reliability of the synthesized findings.

Results: Five studies from Iran, Netherlands, United States (2), and Turkey were included, resulting in 456 pooled subjects, with a mean age of 21 to 38 years and mainly females (52 to 66%). Approximately 1 in 10 patients appointed to OS may present with BDD (14.5% [95% CI 10.83 to 19.15]; I² = 35.1%, P = .18; low certainty of the evidence).

Conclusions and relevance: Regular BDD screening in OS may enhance patient satisfaction and improve treatment outcomes. Future research is required to ensure the generalizability of these findings to other populations.